lecture 78 Flashcards
rogers - pain pt 3
what are the SE of opioids?
antitussive
NV, C
itching
orthostatic hypotension
urinary retention
sedation
respiratory depression
what are the CPs of opioids?
consider staring stool softener and/or stimulant laxative
potential for tolerance, dependence, and addiction
C2 except for tramadol, codeine
how is codeine often formulated?
mixed with other ingredients mostly like acetaminophen or guaifenesin
tablet or cough syrup
what are the CPs of codeine?
depending on strength, it is C2, C3, C5
metabolized via CYP2D6 – poor metabolizer have no effect, ultra-rapid metabolizer can experience OD resulting in respiratory depression/death especially in children
not recommended in breastfeeding mothers or children under 12
how is tramadol often formulated?
capsule ER 24H
tablet - IR and ER 24H
oral solution
combo with tylenol available
what are the CPs of tramadol?
risk of SS when used with other serotonergic meds
renally dose adjusted
C4
what is the boxed warning of tramadol?
use of CYP 450 3A4 inducers, 3A4 inhibitors, and 2D6 inhibitors
requires careful consideration of the effects on the parent drug and metabolite
how is morphine formulated?
capsule ER 24h
tablet – IR and 12 hr ER
oral solution
solution for injection (IM, IV, SQ)
suppository
what are the CPs of morphine?
itching more prominent compared to other opioids
morphine and its metabolites are renally excreted and accumulate in renal dysfunc
US BW of alcohol while taking ER (leading to increased morphine plasma levels and potentially fatal OD)
how should morphine be dosed with renal dysfunction?
CrCl 30-60 mL/min – consider alternate opioid
under 30 mL/min – avoid use in end stage renal disease or AKI
how is hydromorphone formulated?
IR and ER tabs
oral solution
solution for injection
suppository
what is the BW of hydromorphone?
dosing errors when prescribing, dispensing, or admin
ORAL sol – do not confuse mg and mL
IV sol – do not confuse high potency sol (10 mg/mL) with other sol (1, 2, or 4 mg/mL)
what are formulations available for Norco/Vicodin?
oral sol
ER tables
tablet with 5/325 mg, 7.5/325 mg, 10/325 mg
what are the CPs of norco?
counsel pts on tylenol use
US BW with CYP 3A4 inhibitors may increase hydrocodone plasma conc
what are the formulates available associated with oxycodone (including percocet)?
tablet (IR and ER 12 hr)
capsule (IR and ER 12 hr)
oral sol
what are the CPs associated with oxycodone (including percocet)?
counsel pts on tylenol use in combo (dose is 2.5/325 mg, 5/325 mg, 7.5/325 mg, 10/325 mg)
ER capsule/tabs are abuse-deterrent
US BW with CYP 3A4 inhibitors as may increase oxycodone plasma conc
what are the available formulations of fentanyl?
injectable solution
patch
what are the CPs of fentanyl?
can use in renal impairment
less hypotension than morphine/hydromorphone at similar dose
non-injectable forms are ONLY indicated for pts who are opioid tolerant (do not convert one fentanyl product to another on a mcg per mcg basis)
US BW of for CYP3A4 inhibitors and inducers
what is defined as being opioid tolerant?
taking morphine 60 mg per day (or equivalent) for at least 1 week
where should a fentanyl patch be placed?
use on upper chest, outer arm, lower abdomen, or hip every 72 hrs
do not cut patches or use if torn damage (can cause OD)
do not use patch over broken skin
do not let patch get too warm while wearing as body will absorb too much med
when should methadone be used?
last line tx of chronic pain
opioid detoxification
how is methadone formulated?
oral sol
injectable sol
tabs
what are the CPs of methadone?
US BW of QTc prolongation (check baseline ECG prior to initiation)
US BW of 3A4 inhibitors/inducers
have long half of 8-59 hours
how is meperidine formulated?
injectable sol
oral sol
tablet
